Doctors Speak: A Qualitative Study of Physicians' Prescribing of Antidepressants in Functional Bowel Disorders.
Functional bowel
Functional gastrintestinal disorders
Neuromodulators
Qualitative research
Journal
Culture, medicine and psychiatry
ISSN: 1573-076X
Titre abrégé: Cult Med Psychiatry
Pays: Netherlands
ID NLM: 7707467
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
accepted:
01
06
2022
medline:
9
8
2023
pubmed:
29
6
2022
entrez:
28
6
2022
Statut:
ppublish
Résumé
Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as "functional" can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients' expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.
Identifiants
pubmed: 35764862
doi: 10.1007/s11013-022-09795-0
pii: 10.1007/s11013-022-09795-0
doi:
Substances chimiques
Antidepressive Agents
0
Antidepressive Agents, Tricyclic
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
669-683Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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